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President Donald Trump had a lot to say about health care when he gave his State of the Union speech on Tuesday, February 4, claiming that he was determined to protect coverage for preexisting health conditions and that “socialist” Democrats were trying to rob Americans of the health plans they love.

Problem: the Trump Administration is very much on board with a Republican lawsuit that seeks to abolish the protections of the Affordable Care Act of 2010, a.k.a. Obamacare — including coverage of preexisting conditions — and rip health insurance away from millions of Americans by arguing that the law is unconstitutional. And journalist Daniel McGraw points out in a February 10 article for The Bulwark that health care could be a major liability for Trump in the Rust Belt states that he needs to win in order to be reelected in November.

The Bulwark is not liberal or progressive. Founded by Never Trump conservatives Bill Kristol and Charlie Sykes in late 2018, The Bulwark has a right-wing point of view but is passionately anti-Trump. On the surface, it might seem strange that a conservative site would be sympathetic to Obamacare. But in fact, the elements of the ACA were greatly influenced by the “universal health care via the private sector” approach championed by President Richard Nixon, the Heritage Foundation and Mitt Romney (now a U.S. senator) in the past. Nixon never would have favored the type of Medicare-for-all proposal that Sen. Bernie Sanders is pushing for, but the health care overhaul he proposed in the early 1970s and worked on with the late Sen. Ted Kennedy was comparable to the ACA yet more aggressive.

Demonstrating why health care could be problematic for Trump in the 2020 election, McGraw cites the results of Baldwin Wallace University’s Great Lakes Poll (which was published on January 21). Only four states were included in the poll, all of them Rust Belt States that went from voting for President Barack Obama in 2008 and 2012 to favoring Trump over Democratic presidential nominee Hillary Clinton in 2016: Pennsylvania, Ohio, Michigan and Wisconsin.

McGraw explains, “One question in the poll was especially relevant to health care, and unlike the questions in most previous national polls, phrased very directly: ‘Do you approve or disapprove of the way Donald Trump is handling health care policy?’ The results show Trump and the Republicans have a big problem in these key states.”

Respondents who said they “somewhat” or “strongly” disapprove of how Trump has handled health care, McGraw notes, include 53 percent in Michigan, 56 percent in Wisconsin and 51 percent in Pennsylvania. Those figures include both men and woman; among women, the numbers increase to 59 percent in Michigan, 58 percent in Wisconsin and 53 percent in Pennsylvania.

“Exit polls in 2016 showed Trump lost to Hillary Clinton among women in each of those states: by 42-55 in Pennsylvania, 42-53 in Michigan and 43-53 in Wisconsin,” McGraw points out. “He can’t afford to lose even more ground.”

Robert Alexander, an Ohio State University political science professor and one of the people who oversaw the Great Lakes Poll, told The Bulwark that health care is a high priority among older votes in Rust Belt states.

“The aging population in these states is big in terms of numbers, and (health care) is a big issue for them,” Alexander explained. “These people in these states aren’t looking 20 years down the road on how they get health care; it is much more immediate for them. This is a very real issue, and instability doesn’t sell well. Trump’s policy seems to be based on more chaos, and while that might be appealing to some voters on other issues, it doesn’t seem to be that way for the people we polled.”

According to Lauren Copeland (a political science professor at Baldwin Wallace University in Ohio who worked on the Great Lakes Poll), public support for Obamacare has continued to grow.

“People are really skeptical of new policy changes that are imposed upon them,” Copeland told The Bulwark. “What seems to have happened is that the voters (still) saw Obamacare as a new policy in 2016, and were a little leery of it. But now, it is the standard in many ways — and most people don’t want to lose it now.”

If independent voters in the Rust Belt believe that Trump is hostile to their health care needs, McGraw explained, they might swing Democrat.

“Much will depend on who the Democratic candidate turns out to be, but whoever it is, Trump will need to get the independents on his side by at least the same margins as he did in 2016,” McGraw writes. “If health care is, as these independents say, their most important issue — and if they disapprove by large margins of Trump’s handling of health care — his challenge is formidable.

With President Donald Trump in the White House, so many scandals and outrages pour forth every day that the news media has difficulty keeping up, let alone focusing on what is most important.

And though many perceive that media as being broadly critical of Trump — and there’s certainly some truth in this, though most criticism is more than warranted — this dynamic actually lets the president get by with a lot that his predecessors would have gotten slammed for.Consider, for instance, the number of uninsured Americans.

When the Affordable Care Act — AKA Obamacare — was enacted, the uninsured rate in the United States plunged from a peak of 18 percent to 10.9 percent, according to Gallup, representing an increase in the insured population of more than 20 million people, a massive jump. This was a historic achievement, but still, Obama got dogged criticism, much of it fair, for Obamacare’s oversights and failures.

Since 2016, however, the trajectory of health insurance in the United States has completely reversed, Gallup has found. From the low of 10.9 percent in its last year, the uninsured rate ticked up to 13.7 percent, a four-year high. That’s an increase of about 7 million people without coverage. Instead of building on Obama’s progress, Trump has gone backward.

What’s driving this isn’t entirely clear, but reporter Sarah Kliff argued in January that it can be accounted for by rising premiums, the Trump administration’s various efforts to sabotage Obamacare, and the mistaken belief that Republicans have actually repealed the ACA.

But whatever the reason, one thing is clear: Trump has failed on his promise to the American people. For the most part, though, the media just ignores this fact.

Gallup’s numbers were first reported on pretty widely when they were released back in January. But even then, the topic wasn’t a dominant story. It didn’t attract the national news media’s interest the way Obamacare stories did under the previous president.

One might argue that this is only fair, because Obamacare was Obama’s accomplishment, not Trump’s. It’s only reasonable to give greater scrutiny to the uninsured rate when the single largest accomplishment of the sitting president is a health care law.

But though it’s easy to forget, Republicans were all about health care for a long time, too. Since 2010, when Obamacare passed, the GOP has promised to repeal it. It was a central theme of every election. In 2016, Trump himself said not only that he would repeal and replace Obamacare but that he would replace it with something much better. “We’re going to have insurance for everybody,” he said.

“I am going to take care of everybody,” he told CBS’s “60 Minutes.” “Everybody’s going to be taken care of much better than they’re taken care of now.”

It wasn’t just Trump. Paul Ryan pledged in discussing repeal and replace: “We want every American to have access to quality, affordable health coverage.”

Now, when the subject is discussed, what’s typically mentioned is the fact that Trump failed to repeal and replace Obamacare. Or the fact that, despite their promises to keep its protections in place, the Republican Party and the Trump administration have lined up behind a legal challenge that could prompt the Supreme Court to eradicate Obamacare root and branch. Or the administration’s efforts to promote junk health insurance plans.

All of this is important. And yet in all these arguments, it seems the thread has been lost. Despite his explicit promises the contrary, health care has already become more difficult to get under President Trump, and millions more people are going without insurance. This is either directly because of actions his administration has taken or because of his failures to live up to his promises. There are many other scandals going on every day in the news cycle, so it’s understandable that this fact could get lost.

But the failure of this fact to land on the national radar also comes from a more pernicious fact: reporters never took the GOP’s or Trump’s claims to want to improve health care in the United States seriously. Even when they reported Republicans’ claims credulously, almost anyone in a position to professionally cover politics knew enough to be confident that the party really didn’t care about or intend on increasing the number of people who have insurance.

So when Trump actually led to an increase in the uninsured rate, this didn’t seem like much of a surprise or revelatory story. Contrast this to reporter’s attitudes under Obama, who’s every health care failure was regarded (rightly!) as a serious story. In this way, the GOP’s duplicity is rewarded, while Democratic sincerity is punished.

But health care is still a top-tier issue that voters care about it. The media would better serve the public by making Trump’s galling failure clear.

Wonks can be useful people. Having studied the deep innards of public policy, wonks are essential to constructing programs that can function as desired. They help write complicated laws. But whereas wonks may know all the parts that make a clock work, they are usually not good at selling the clock. You need marketers for that.

Politicians are the marketers. They tell ordinary people what’s great about their proposals. When they have to drag a wonk onto the stage to explain something — or have to play the wonk themselves — they’re in trouble.

Enter section 1325, part of Title 8 of the U.S. Code. You still here? Democratic presidential candidate Julian Castro is pushing the idea of getting rid of section 1325. Doing so would make it no longer a criminal offense to be an unauthorized immigrant in the U.S. It would, however, still be a civil offense. As proposals go, this is dumb on a number of levels, above all the political one.

Castro was mayor of San Antonio, America’s seventh biggest city. It surprises me that this savvy, polished, and pragmatic Texas politician would propose this kind of tinkering with the law.

Why on Earth would he, in effect, decriminalize illegal border crossings when Americans are so concerned about illegal immigration?

Preet Bharara asked that of Castro on his popular podcast. Castro elucidated: Decriminalizing illegal entry but leaving it as a civic infraction would not prevent an undocumented immigrant from being deported. (The online wonks offered similar explanations.)

The scary part is that Castro and other Democrats who endorsed his idea apparently think that the great American non-wonk majority will hear this as a moderate salve for the crisis at the border — as something that makes entering the country illegally still illegal but just a little less so. If it’s not going to make that huge a difference, why even push something that sounds like a relaxation of border controls?

Let’s move on to Medicare for All. Sure, polls show large numbers of Americans liking the idea. But when asked about whether they want a new health care system that would end the private coverage — which a true Medicare for All plan would do — large numbers say they don’t. And these are largely the same people.

Guess what. The public doesn’t do wonkery. Bernie Sanders insists that once the American people understand the savings of his plan, they won’t mind paying higher taxes and losing their coverage through work. Furthermore, many aren’t especially happy with their private coverage.

The above may be true. That doesn’t mean that the public can follow along. (Alternatively, everyone could be required to take a night class on health care economics.) And however Americans feel about their private insurance, they may not be ready to dive into the great unknown.

Wouldn’t strengthening the Affordable Care Act and adding a public option — a government-run health plan that would compete with private plans — be the easier sell? Joe Biden is championing the idea.

Other Democratic candidates promoting Medicare for All have panned Biden’s public option proposal as not radical enough. But they have very short memories.

The public option was originally part of the ACA bill and had to be yanked out because even some Democrats were afraid to support it. The Wall Street Journal opinion pages, meanwhile, have burst into flames with warnings that a public option would destroy the private health insurance industry.

Wonks adjust the wheels and gears of public policy. When they’re done, they should go home and let the politicians take over. If politicians can’t sell their idea to ordinary people, the idea is in trouble.

WASHINGTON — Congress returned Tuesday to deal with some unfinished business from 2015 and to forge a legislative agenda that could shape the 2016 presidential and congressional elections.

Here’s a look ahead.

Health care

The House of Representatives will vote on a measure this week to repeal the Affordable Care Act, President Barack Obama’s legacy accomplishment.

The bill would strip key elements from the ACA, including the individual mandate to have insurance or pay a fine and the employer mandate to offer insurance. The measure also contains a provision to eliminate federal funding for Planned Parenthood, a goal of conservative Republicans after secretly recorded videos surfaced last year that reportedly showed an employee of the organization discussing the sale of fetal tissue.

This is the health care repeal bill that the Senate passed before adjourning for the holidays. If the bill clears the Republican-controlled House, it would be the first ACA repeal measure to reach Obama’s desk.

Obama would certainly veto it. Still, Republicans view getting it through both chambers of Congress as a symbolic victory they can take on the 2016 campaign trail.

Syrian refugees

Republicans intend to battle Obama’s plan to bring 10,000 Syrian refugees to the United States, fearing that the Islamic State and other terrorists could enter the country through the resettlement program.

Senate Majority Leader Mitch McConnell, R-Ky., placed a House-passed bill on the Senate calendar that would restrict the flow of Syrian and Iraqi refugees. It was written by Rep. Richard Hudson, R-N.C., and House Homeland Security Committee Chairman Michael McCaul, R-Texas.

This could present problems for House Speaker Paul Ryan, R-Wis. Several conservative Republicans expressed displeasure that the omnibus spending bill didn’t include measures to stall or prevent Obama’s resettlement plan.

Last month, 95 of 246 House Republicans voted against an omnibus government spending bill Congress passed, in part because it didn’t address the Syrian refugee issue.

The Islamic State

While the debate over Syrian and Iraqi refugees rages, Ryan said he’d like Congress to pass a war powers resolution against the Islamic State, commonly known as ISIS.

“It would be a good symbol of American resolve to … go after ISIS, to thoroughly defeat and destroy ISIS,” he said last month.

Depending on how such a resolution is crafted, lawmakers could find a receptive White House. Obama said in a televised speech last month, “If Congress believes, as I do, that we are at war with ISIL (another abbreviation for the Islamic State), it should go ahead and vote to authorize the continued use of military force against these terrorists.”

Gun control

The debate over guns is one of the most contentious issues on Capitol Hill and the campaign trail. Obama and congressional Democrats are arguing for stricter gun control measures in the aftermath of the terrorist shootings in San Bernardino, Calif., that killed 14 people.

Obama intends to use executive action to place new curbs on guns, reportedly including requiring more gun sellers to conduct background checks on purchasers.

Lawmakers and Republican presidential candidates are already accusing Obama of executive overreach. “Such an expansion of governmental power would represent an abuse of one of the core individual rights protected by our Bill of Rights,” Rep. Mark Sanford, R-S.C., said Monday.

Criminal justice overhaul

Obama wants it, the conservative Koch brothers want it, most of the 2016 presidential contenders want it, and the House and Senate have proposals to do it.

Revamping the nation’s criminal justice system may be one of the few areas where the political parties and differing ideologies find common ground. And it will be difficult.

Senate Democrats have concerns about a House overhaul bill that they contend would make it more difficult to sue corporations. The Senate criminal justice bill made it through the Judiciary Committee in October with provisions that limit mandatory minimum sentences for nonviolent offenders and give judges more leeway in some sentences. Four Republicans on the committee — Sens. Ted Cruz of Texas, Orrin Hatch of Utah, David Vitter of Louisiana and David Perdue of Georgia — voted against it.

Photo: U.S. Speaker of the House Paul Ryan (R-WI) holds a news conference on Capitol Hill in Washington November 19, 2015. REUTERS/Gary Cameron

About The National Memo

The National Memo is a political newsletter and website that combines the spirit of investigative journalism with new technology and ideas. We cover campaigns, elections, the White House, Congress, and the world with a fresh outlook. Our own journalism — as well as our selections of the smartest stories available every day — reflects a clear and strong perspective, without the kind of propaganda, ultra-partisanship and overwrought ideology that burden so much of our political discourse.